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The pharmacy losing £1.5k a month from pausing its services

Hitesh Tailor owns The Village Pharmacy in Harlington, west London
Hitesh Tailor owns The Village Pharmacy in Harlington, west London

After stopping its medicine use reviews (MURs) at the beginning of the COVID-19 outbreak so it could focus on dispensing, one pharmacy is still recovering from the financial losses

A surge in demand for prescriptions during the COVID-19 pandemic has put other daily tasks in the pharmacy, including clinical services, on hold indefinitely.

Hitesh Tailor, who owns The Village Pharmacy in Harlington, west London, says he depends on the income from MURs and the new medicines service, which normally generate up to £1,500 a month.

However, throughout most of March Mr Tailor was too busy to carry out these services. He is going to have to work harder to try to make up for the income loss, he says.

Long hours and mental health pressure during the pandemic at times pushed the pharmacy team to breaking point.  “We’ve had a few people that were off sick, not with COVID-19 but just general anxiety, and other issues as well, so it was like the perfect storm.”

However, the worst now seems to have passed. “I’ve got some really good staff here and we just managed to pull through,” Mr Tailor says.

Paying wholesalers

Community pharmacies in England are receiving £300 million in advance funding over April and May to alleviate cashflow issues caused by the pandemic, but the sum will have to be repaid.

Mr Tailor says he’s not sure how much the funding is going to help. For a period, the surge in demand saw an increase of around 25-30% on the usual volume of prescriptions. But he won’t receive reimbursement from the NHS for a few months, so paying wholesaler bills is “going to be an issue,” he says.

His bills have been impacted by the escalating costs of some medicines. The price of hydroxychloroquine and chloroquine went “extremely high”, he says, following rumours that they could be used to protect against or treat COVID-19.

The Medicines and Healthcare products Regulatory Agency published a statement on March 25 stressing that while clinical trials were ongoing, no conclusions had been reached on  the “safety and effectiveness” of treating the virus with these medicines.

Mr Tailor has also had to handle shortages of over-the-counter products. “Things are slowly starting to come around, but it was that manic last two weeks in March, it just went crazy, everything was wiped out,” he says. Items affected by shortages include Calpol and paracetamol, which Mr Tailor says are now starting to come through, vitamin C, still in “very short” supply and hand sanitiser.

However, the stress of dealing with medicine supply issues has been helped by patients in his area becoming more understanding of delays, despite pharmacies elsewhere reporting a rise in abuse from patients.

“People are getting used to the idea of taking their time. They haven’t got to rush to work, they’ve got nothing else to do apart from shopping or coming to the pharmacy. There’s always queues outside but that’s fine for most people.”

PPE problems

However, trouble acquiring personal protective equipment (PPE) has also affected Mr Tailor’s pharmacy. He’s having to source it himself for the pharmacy team, and says that’s costing a lot. “PPE should be readily available for us because we are facing patients everyday – we’re not to know whether people have COVID-19 or not.”

NHS England has said  pharmacies should be able to order PPE for staff from their wholesalers. But contractors have struggled to get PPE throughout the COVID-19 outbreak. The government is facing at least two judicial review cases over the supply problems, according to legal  expert David Reissner.

Many of the pharmacies in Middlesex, near Mr Tailor’s pharmacy, have had issues acquiring PPE. Vasundra Tailor, consultant pharmacist at the Middlesex Group of Local Pharmaceutical Committees (LPCs) told C+D last month (April 16) that most local contractors were still waiting for PPE and COVID-19 tests.

“Many of our pharmacists are struggling with the additional workload, drug shortages, impatient patients and keeping up with new directions coming at them at high speed,” says Ms Tailor. “We at the LPC are doing our best to support them through this.”

While there have been no pharmacy closures in the area yet, there have been unplanned reductions in opening hours due to staff shortages, Ms Tailor says.

Battling against COVID-19 has been trying for the team at The Village Pharmacy, leaving Mr Tailor feeling exhausted, but he is now recuperating and looking to the future for his business.

How has your pharmacy been affected by COVID-19?

David Kent, Community pharmacist

Yet another tale of crocodile tears. I assume Mr Tailor has more than recouped the spurious figure he gives for losses due to increased dispensing volume.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

You can't make a profit from dispensing. It's all about services now. Increased dispensing volume will just increase losses.

R A, Community pharmacist

I agree increased volume leads to increased expense so the net position remains the same. 

A business is only profitable in one of two scenario i.e. it has high profit margin or the business has low profit margin but costs are fixed therefore high volume is key to increasing profit. Something that seems to have evaded community pharmacy for a long time. 

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Unless you have good deals with your wholesalers, tariff prices are often well below cost prices so increased dispensing actually increases losses. It's been obvious for some time that, although it is still an 'essential' service, dispensing is actually bleeding pharmacy dry, both for this reason and for the man-hours required.

Ryszard Cygan, Superintendent Pharmacist

RESILIENCE - "the capacity to cope and recover quickly from difficulties"

This is a slightly misleading story and I don't believe that Mr Tailor has been totally honest with his numbers. For the year April 2019 - Mar 2020, the total permitted MUR's was 250. By February, Mr Tailor had actually already completed 247. So he was only three short of the total to complete in March i.e. 3 x £28 = £84. Mr Tailors monthly average prescriptions dispensed is 6,274 items. That means, based on his prescription numbers, he would be paid the maximum amount for completing 30 NMS consultations (which he actually achieved for the first time in February) which is equivalent to £840. So his total potential maximum loss on advanced services for March would have actually been no more than £924 and not £1,500 as claimed. This would assume that he had completed no MUR's or NMS's at all. 

Furthermore, I am surprised that anyone is still hinging their pharmacy business around MUR's. For the year April 2020 to March 2021, pharmacists will be able to carry out just 100 MUR's, before they are scrapped all together. Possibly working on a 'Plan B' may be useful. One of the reasons why MUR's are being scrapped is in many ways reflected in this article as many pharmacists and chains saw the MUR as a way of supplementing income first and as a service second rather than a vital service for which we were appropriately remunerated. 

Finally, every single pharmacy in the land was faced with identical pressures in March with a massively increased dispensing volume. In addition to the March advance payment, pharmacists were given an additional advance circa 25% extra of their March advance. This was meant to help with increased wholsaler costs incurred that would need to be settled a month prior to being paid the March balance. Yes, this is only a loan, but it was meant to see pharmacies through these difficult times. 

Clearly, the lesson that all pharmacists, both independents and multiples, need to learn is that the pharmacy business model is broken and completely lacks resilience and needs to change as this article clearly demonstrates. Those pharmacists that have long ago removed MUR's from the equation and reworked their business model and moved on, I am pretty sure have faired much better in these difficult times. 

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

The 'value' of MUR has only been relevant to multiples for a long time now. I know of very few indies that actually bother doing them (except the dead easy ones). They were a lame duck from the start because the only ones that would actually benefit patients, i.e. the patients with complex regimes, were the ones that were actively avoided because they took too long while all of the other work was backing up.

R A, Community pharmacist

As a pre-reg I couldnt understand how the sector was going to be sustainable way back in 2010. When a business relies on volume and cutting cost to make profit it means the margin for safety is extremely narrow. This continued to nag me until 2015 I decided all togather not to invest in Community Pharmacy.

Boom Shakalaka, Locum pharmacist

I believe the money set aside for services has been reallocated to the global sum, therefore distributed accordingly.

ash mohindra, Community pharmacist

the hmrc grant is not 25000 it is depends on your rateable value 

Keith Sykes, Community pharmacist

Supervised consumption has become fortnightly take home. Resulting loss of income is substantial.

N patel , Non Pharmacist Branch Manager

HMRC has given all indepdent pharmacies 25k grant, that should cover it

Dave Downham, Manager

Almost as inaccurate a comment as your spelling.

Industry Pharmacist, Head/Senior Manager

From what I've been told, this is pretty normal in the pharmacy world today. How can you expect profit when the Government are making more cuts and the regulators demand more money.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Absolutely no money in any of our essential services any more, unless you are lucky enough to have lots of private patients, retail not too bad but you have to have a big store to make it profitable enough, MUR disappearing, replaced by the rubbish that is CPCS which has died a death because of covid, NMS still going but no time to do it, again because of covid. Daft thing is, there is no real reason why pharmacy should be any busier because of an untreatable viral illness which is only affecting a tiny proportion of the population, but it is. It's like the christmas panic on steroids and going on for weeks. Pharmacy is rapidly going to hell in a handcart, and when we're gone, we will be missed as much as Woolworths pick and mix (and I REALLY miss Woolies pick and mix)

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